Transcript Behavioral Management and Psychosocial Interventions

Thank you, Dr. Ballentine!
• All the information presented could be helpful
to you as community Geriatric Resource
Nurses, as you deal with vulnerable older
adults who may be wanting to stay in their
homes as long as possible.
• The complex issues facing these older adults
are best handled with a collaborative team
effort of specific inter-professionals,
depending on the challenges being faced.
Your Important Role
• As a community GRN, you have the skills,
knowledge, and resolve to
– Contact the inter-professionals needed
– Coordinate their efforts
– Follow-up so that the vulnerable older person
continues to receive the care he or she needs
• As a care-giver yourself, please make sure you
have the inter-professional team support you,
as you support the vulnerable older person
and his/her family care-givers.
Case Review
Mrs. Johnson is a 83 year-old woman who
resides with her daughter in her home. She was
transferred to the acute care hospital due to
increasing agitation, confusion and difficulty
breathing. Mrs. Johnson has the diagnosis of
Alzheimer’s Disease and Depression, Atrial
Fibrillation, Congestion Heart Failure, and
Severe Degenerative Disc Disease. Her
daughter is supportive and would like to care
for her mother at home.
Case Review
Medication List from Home:
No Known Drug Allergies
Digoxin 0.125mg every day
Lasix 40 mg every day
OxyContin 10 mg TID
Oxycodone 5-325mg every 4hrs as needed for pain;
Lexapro 20mg daily
Aricept 10 mg OD
Namenda 10 mg BID
Gabapentin 300mg 2tabs 3 times daily;
Omeprazole 20mg daily;
Case Review
Chief Complaints:
• At the Emergency Room Mrs. Johnson presented
with difficulty breathing and increased agitation
and confusion. Chest X-ray shows left lower lobe
pneumonia.
• Mrs. Johnson was started on IV anti-biotics, given
Ativan 0.5 mg due to her agitation and Oxygen at 2
liters.
• Due to her lethargy upon arrival from the ER Mrs.
Johnson’s pain medication was not transcribed for
admission to the medical unit.
Case Review
Chief Complaints (cont.):
• Mrs. Johnson was admitted to the medical unit
without difficulty and slept most of the first 24 hours.
• When her daughter visited her the second day of
admission her mother was complaining of increasing
anxiety, agitation and vivid dreams of people trying to
harm her. Her daughter noticed her confusion was
increasing.
Case Review
Chief Complaints (cont.):
• When the daughter asked the nurses to verify her
mother’s medication she discovered her mother was not
receiving her pain medication nor the medication for her
dementia.
• The nurses reassured the daughter her mother did not
appear to be in pain.
• The daughter was concerned that her mother may be
going through withdrawal as she has been taking it for
over a year. She felt the symptoms of increased
confusion, agitation, and “vivid dreams” were symptoms
of withdrawal.
Case Review
Chief Complaints (cont.):
• The daughter asked the nurses to verify the orders for
pain medication and the medication to slow the
dementia.
– She was concerned about withdrawal from the narcotic
– She was concerned about the potential to decline without
the “medications” for Alzheimer’s disease.
• When the daughter returned that evening neither of the
medications had been ordered. She contacted the
Nursing Supervisor and the patient care advocate.
• The daughter began to advocate for an early discharge
home.
Case Review
Upon discharge what issues need
to be addressed to assist the
patient and family to maintain her
placement in the community?
Case Review
• Current Social issues:
• Mrs. Johnson resides in her daughter’s home.
• The daughter attends a monthly Alzheimer’s
Support Group
• The daughter has members of her church stay
with her mother so she can go shopping and out
with friends once a week for 2 hours.
Case Review
Current Psychiatric Issues:
• Mrs. Johnson is currently taking medications for
depression and to slow the Alzheimer’s disease:
Lexapro 20 mg daily
Aricept 10 mg Daily
Namenda 10 mg BID
• Prior to the current emergency room visit there
have been no behavioral issues.
Case Review
Communication Issues:
•Ensure discharge planning to include identified
staff to be primary care manager.
•Communicate with patient’s Primary Care
Physician regarding the discharge medication
and outpatient community based plan.
•Ensure medication continues throughout
continuum of care.
Case Review
Functional Issues:
• Patient returned home after 3 days of
inpatient hospitalization.
• Mrs. Johnson was ambulating with assistance
at the hospital on day 2.
• PT evaluation felt an In-Home PT and
Occupational evaluation would support the
plan to remain at home.
Case Review
Client’s Strengths/Resources:
•Patient has supportive family and resources.
•Daughter has some knowledge of home and
community-based services.
Case Review
• Which professionals need to be
involved for this individual to receive
good care in the community?
Case Review
• How would you as a GRN facilitate the
involvement of these professionals and
their collaboration with you and each
other?
Case Review
• What else would you as a GRN do for
follow-up?
Reminder:
• Our next Inter-Professional and Geriatric Case
Reviews will be held May 23rd from 12:30 –
2:00 PM. Please register via the Survey
Monkey link that is emailed to you the week
before.
• Mark your calendars for our Fall 2012 InterProfessional Case Reviews and Geriatric
Case Reviews from 12:30 to 2:00 PM:
– October 17th
– November 14th
– December 12th
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Reminder: Save the Date
• Mark your calendars: the next GRN SemiAnnual training will be held via Webinar on
December 3rd from 12:15 – 3:15:
 Topic – “Update on Alzheimer’s Disease
and Dementia”
Presenters: David Gill, MD (pending) and
Linda Shumaker, RN—BC, MA
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Reminder: Responsibilities of
Participants
• You need to complete a new demographic
form (Required for PSNA Contact Hours).
This is to meet one of the requirements of our
funder for this project. This will be available at
the website for the link to the evaluation form
(see below).
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Reminder: Responsibilities of
Participants (cont.)
• You will be emailed a link to the evaluation
form, which includes the post-test question
and attestation, after this training has
concluded. This must be completed no later
than midnight on Wednesday, May 16th. The
post-test is ONE question! You will not be
awarded your PSNA certificate unless you
complete the entire evaluation form, including
the attestation, post-test, and a new
demographic form (found at same link).
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This is the link:
www.olderpa.org/grnho
Thank you for your attention,
hard work, and commitment
to helping older persons in
your community receive the
best care possible through a
collaborative, interprofessional team approach.
Please use the GoogleGroup
to network with each other,
ask for advice, give advice,
share resources, etc.
It takes a village….